San Antonio Medicine April 2016

MEDICINE SAN ANTONIO

THE OFFICIAL PUBLICATION OF THE BEXAR COUNT Y MEDICAL SOCIET Y

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APRIL 2016

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VOLUME 69 NO. 4

Transplants & Transfusion

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MEDICINE SAN ANTONIO

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Transplants & Transfusion

By Rachel Beddard, MD and Samantha Gomez Ngamsuntikul, MD ..................12

Everything you want to know about platelets

A good Samaritan to the very end

By Mike W. Thomas .........................................16

SUBSCRIPTION RATES: $30 per year or $4 per individual issue

Turning no into yes at the nation’s largest living donor hospital

By Francis H. Wright, MD, FACS ........................................................................20

BCMS President’s Message ...........................................................................................................8 BCMS Legislative News................................................................................................................10 Business of Medicine: Physician compensation arrangements – fraud alert by Pamela C. Smith, PhD ....................................................................................................26 Non Profit: TOSA ...........................................................................................................................28 Lifestyle: Heavy Medal by Carole Miller ..................................................................................................30 Grandma and her Medicare by Jeffrey Pyle............................................................................................32 Book Review: This Old Man by Roger Angell, Reviewed by Fred H. Olin, MD .......................................34 Financial Health: Can financial stress effect my health? by Abbey Carnes ............................................36 BCMS News..................................................................................................................................39 UTHSCSA Dean’s Message By Francisco González-Scarano, MD ........................................................42 BCMS Circle of Friends Services Directory .............................................................................................46 Auto Review: 2016 BMW 640i, By Steve Schutz, MD..............................................................................52

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Update on “Treatment and Management of Hematologic Malignancies”

By Paul Shaughnessy, MD ................................18

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APRIL 2016

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BOARD OF DIRECTORS

OFFICERS Jayesh B. Shah, MD, President Sheldon Gross, MD, Vice President Leah Jacobson, MD, President-elect James L. Humphreys, MD, Immediate Past President Gerald Q. Greenfield Jr., MD, PA, Secretary Adam V. Ratner, MD, Treasurer

DIRECTORS Rajaram Bala, MD, Member Jorge Miguel Cavazos, MD, Member Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member John W. Hinchey, MD, Member John Robert Holcomb, MD, Member John Joseph Nava, MD, Member Bernard T. Swift, Jr., DO, MPH, Member Francisco Gonzalez-Scarano, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Carlayne E. Jackson, MD, Medical School Representative Jennifer Lewis, BCMS Alliance President Roberto Trevino Jr., MD, Board of Censors Chair Jesse Moss Jr., MD, Board of Mediations Chair George F. "Rick" Evans Jr., General Counsel

CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer

CHIEF OPERATING OFFICER Melody Newsom Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director Alice Sutton, Controller

COMMUNICATIONS/ PUBLICATIONS COMMITTEE Rajam S. Ramamurthy, MD, Chair Kenneth C.Y. Yu, MD, Vice Chair Fred H. Olin, MD, Member Esmeralda Perez, Community Member David Schulz, Member J.J. Waller Jr., MD, Member

6 San Antonio Medicine • April 2016

PRESIDENT’S MESSAGE

How can your idea become legislation?

By Dr. Jayesh Shah, 2016 BCMS President

Did you know that every BCMS member has the opportunity to write a resolution and get involved in producing legislation at the grassroots level?

If you sometimes wonder how you can contribute when you identify a problem with the practice of medicine, this is what you should do. Take the problem that you found and use it as an opportunity to find and suggest a solution in the form of a resolution. As a member of the county medical society, you can write a resolution which can be submitted to BCMS. The BCMS Delegate Committee reviews all resolutions that are submitted by BCMS members. If the committee agrees, the delegates present the recommendation as a resolution from the county society at the next meeting of the TMA House of Delegates. If your resolution is not adopted by the county society, you can still submit it directly to the TMA House of Delegates without the county society’s endorsement for consideration by the TMA House. TMA sections also may submit resolutions.

Boards, councils, and committees (and sections) also develop ideas and recommend actions through reports (not resolutions) to the house.

Resolutions are structured to express the background of the problem in “whereas” clauses and to specify a specific position or course of action in one or more “resolved” statement(s).

If your idea or resolution is already a policy, you can find that out by searching the AMA or TMA website. It is always a good idea to search relevant policies while writing a resolution. Once 8 San Antonio Medicine • April 2016

you submit a resolution to TMA, the staff will add a fiscal note to your resolution so that if approved, it can be included in TMA’s next year’s budget. Please note that only the resolved statements of resolutions are acted upon by the House and become association policy statements or directives. If your resolution has directive to go from the AMA House of Delegates then it is reviewed by the AMA delegation from TMA. If you need help, BCMS has a lot of resources including staff person, Mary Nava, Director of Governmental Affairs, who will help and guide you to write your resolution. I would like to encourage everyone to get involved, write a resolution, and be a part of the BCMS delegation to TMA. You can also serve on the Reference Committee or get involved in other county society committees.

Get involved. Individual members have the power to change things and there is a mechanism in place so your voice can be heard. I am attaching a resolution this year that was brought by a BCMS member which was approved by the BCMS delegation.

The TMA House of Delegates will discuss this resolution at the TEX MED annual meeting on April 29-30 in Dallas.

See you all at the TMA meeting. One of our past presidents, Dr. David Henkes, is running for president-elect and we need you all to be there to support his candidacy.

See you there.

Dr. Jayesh Shah

BCMS LEGISLATIVE NEWS

With ELECtiON SEASON iN FULL SWiNG,

BCMS phySiCiANS CONtiNUE viSitS With LEGiSLAtOrS

By Mary E. Nava, MBA, chief government affairs officer With the March 1 primary approaching, the month of February offered opportunities for physicians to attend a number of legislative receptions. Many thanks to BCMS members who participated in discussions with elected officials and candidates in recent weeks.

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2 (Photo 1)BCMS physicians attended a TEXPACsponsored event on Feb. 17 at The Palm Restaurant in honor of Sen. Carlos Uresti (District 19). Pausing for a photo with Sen. Uresti were (l-r): Mark Welborn, MD; Bernard Swift, Jr., DO; Uresti; Jesse Moss, Jr., MD; Michael Battista, MD and Alex Kenton, MD. (Photo 2) On Feb. 17, BCMS members visited with candidate for House District 118, Tomas Uresti, (standing left), who was in attendance at his brother's reception.

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10 San Antonio Medicine • April 2016

(Photo 3) Physicians representing Bexar and Comal county medical societies attended a TEXPAC-sponsored reception on Feb. 24 honoring Rep. Doug Miller (District 73-New Braunfels) at the home of Drs. Michelle and Fausto Meza in New Braunfels.

Doctors in attendance included (l-r): Parin Shah, MD; Jesse Moss, Jr., MD; Miller; Michelle Meza, MD; Fausto Meza, MD and Jeffrey Paul MD. (Photo 4) BCMS physicians attended a reception in honor of Rep. Rick Galindo (District 117) on Feb. 25 hosted by Drs. Ryan and Christine Van Ramshorst at their home in Alamo Ranch. Among the attendees were (l-r): Janet Realini, MD; Galindo; John Holcomb, MD; Christine Van Ramshorst, MD; Ryan Van Ramshorst, MD and Rene Perez, MD.

TRANSPLANTS & TRANSFUSION

BLOOD

TRANSFUSION ANd thE LiFESAviNG MESSAGE OF dONAtiON

By Rachel Beddard, MD and Samantha Gomez Ngamsuntikul, MD BioBridge Global

If you ask a group of people what the most common transplant is, the answers you receive will range from kidney to bone marrow transplants. In reality, red blood cell transfusions characterized by the transfer of red cells from a donor to a recipient represent the most common type of transplant.

Across the country, tens of millions of these transplants occur every year. The majority of these transplants are uneventful. Although rare, “rejection” can occur in the form of acute or delayed hemolytic transfusion reactions leading to destruction of the red cells. One of most dreaded complications of transfusion is an ABO incompatible red cell transfusion. Mostly due to clerical error, the transfusion of A blood type red cells into an O blood type patient can lead to activation of complement and ensuing intravascular hemolysis.

Less dramatic are the development of HLA (human leukocyte antigen) antibodies from frequent platelet transfusions that can lead to platelet destruction or lack of the “platelet bump” on a complete blood count or CBC. In addition to rejection, transfusion associated microchimerism has recently been identified to occur in transfused recipients. Although poorly understood, transfusion-associated microchimerism is the presence of a donor population of white cells long after transfusion.

Although some transfusions are able to leave a long-lasting footprint, the majority of transfused cells have a short life span of only three months. We are grateful to the donors who come in to donate.

There are plenty of opportunities to donate at BioBriodge Global.

This month, we especially celebrate those donors who give whole blood, platelets, peripheral blood stem cells (PBSC), umbilical cord 12 San Antonio Medicine • April 2016

blood and tissue for transplant. Through our non-profit subsidiaries — the South Texas Blood & Tissue Center, GenCure and QualTex — our organization recovers, processes, tests and matches patients and delivers these precious components to be transplanted into those in need around the world.

Our best-known subsidiary, the South Texas Blood & Tissue Center, collects whole blood, plasma and platelets for victims of trauma, as well as patients undergoing treatment for cancer and those undergoing surgery. In 2015, more than 100,000 donors walked through our doors at South Texas to donate and help save hundreds of lives.

GenCure works with the Donate Life organization to register Texans for posthumous organ and tissue donation. The GenCure Tissue Center recovers musculoskeletal, cardiovascular tissue as well as tendon and skin, which are then processed for transplant. The tissues are made available to doctors across South Texas, the nation and world. The center processes more than 100 types of tissue components, from transplants for burn victims to those suffering from bone trauma and spinal dysfunction, to restorative implant dentistry, to a multitude of other orthopedic procedures.

With the tissue donations, we do not forget the families of our

TRANSPLANTS & TRANSFUSION generous tissue donors. The center’s bereavement program holds community events and provides educational resources for those who have suffered the loss of a loved one and are considering tissue donation. Transplant recipients are active in events honoring those who have donated.

GenCure also collects peripheral blood stem cells (PBSC) and mononuclear cells for autologous transplant and research worldwide. The center collected 85 units for transplant last year from donors throughout a multistate region; donors came from as close as San Antonio and as far away as Oklahoma.

The GenCure Marrow Donor Program works in partnership with the ‘Be The Match’ bone marrow registry, recruiting donors from across South Texas to match PBSC recipients suffering from blood cancers across the globe. The center added more than 80,000 names to the registry in 2015, making a special effort to boost the population of under-represented minorities in the database.

GenCure also operates the Texas Cord Blood Bank, collecting, processing and storing umbilical cord blood donated by mothers after healthy births. Cord blood is a rich source of stem cells and can be used as an alternative to bone marrow transplants when matches have not been found. Last year, 48 cord blood units collected by GenCure were sent for transplant around the world. A success story via cord blood is A.J. Salazar, who was diagnosed with acute myeloid leukemia when he was 4 years old. He started college in the fall of 2014 – thanks in large part to a cord blood transplant.

The cord blood was collected when his sister Brianna was born two months after his diagnosis.

“They’re stunned every time I tell the story,” said Roxanne Salazar, their mother. “Brianna can’t believe she actually helped save her brother’s life. We explain to them what happened and that Brianna gave him a second chance.”

The recipients are the biggest cheerleaders for donation. From those who give blood products, to those called to save a life via stem cells, to mothers who donate umbilical cord blood, many understand the need to be part of something bigger than themselves.

“My friends don’t see the importance of giving, and I just don’t know why,” says Marcos Perez III, a San Antonio postal worker who has donated more than 90 gallons of blood and platelets in the past 40-plus years. “One donation saved my life a long time ago. I want to give back.”

“You never know when it’s going to hit you, when you’re going to need the help,” says Maria Garcia, who received multiple units of platelets in 2008 when she was being treated for idiopathic thrombocytopenic purpura. Since then, she has been active on social media, encouraging everyone she knows to donate blood and platelets — even while she was undergoing treatment for cancer.

“If you cannot donate, encourage other people to donate,” she said. “That’s what I do.”

The commitment to selflessness among our donors is year-round, and we’re recognizing it specifically in April, which is National Donate Life Month. BioBridge Global is committed to both promotion and education about donation. In addition to committed donors and their thankful recipients, it takes the commitment of health-care providers to educate patients, families and the community about how donation can make a difference in the lives of so many. As medical professionals, we’re in a position to dispel donation myths and demonstrate the ability in all of us to profoundly affect the community. This month take the time to encourage even one person you know to go out and donate. visit us at www.bcms.org

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TRANSPLANTS & TRANSFUSION

Everything You Want To Know About

platelets Courtesy of South Texas Blood & Tissue Center

So what are platelets?

Platelets are one of the major components of your blood. When they’re sailing around your bloodstream, platelets look like little saucers — sort of streamlined little brothers of red blood cells.

When there’s a break in a blood vessel, platelets become “activated.” Activated platelets look like aliens from a 1950s sci-fi movie.

They’re full of what appear to be tentacles, which help them bind together and encourage other blood-clotting components to join in, in most cases plugging an opening in an artery or vein.

Platelets were first described by the British scientist George Gulliver in 1841, observed under one of the earliest microscopes.

Who needs platelets?

People who have traumatic injuries need platelets beyond what their bodies can produce. People who are undergoing cancer treatments need platelets, because the treatments can reduce the amount of platelets their bodies produce. And people who are receiving transplants often need them as well.

how do you collect platelets?

There are two typical ways to collect platelets.

If you donate whole blood, after your donation is done, we use a system that separates the platelets from the red blood cells and the plasma, the liquid that carries the platelets and red cells through the bloodstream. To make a unit large enough to raise an adult’s platelet count, we need to combine four to six of these separate donations.

14 San Antonio Medicine • April 2016

You also can donate just platelets using a process called apheresis.

Your blood goes through a machine that separates the platelets and returns the rest of the components to your body. This produces one to three units large enough to affect an adult patient’s platelet count.

Why should i donate platelets?

Essentially, two reasons.

First, they’re in high demand, especially for cancer patients. Second, they have a short shelf life, typically five days or less. The problem is that they become sticky very easily, so they can’t be refrigerated and they have to be agitated constantly.

Other blood components can be refrigerated and/or stored frozen for longer periods of time. But not platelets.

how long does it take to donate platelets?

An average donation takes about two hours, or the length of “The Dark Knight.”

how often can i donate platelets?

You can donate about every seven to 10 days, up to 24 times in a year.

What are the requirements?

You have to be at least 17 years old, weigh at least 110 pounds and be in good health. Also, your body needs to have a certain platelet count — which we’ll measure — to see if you are able to donate.

how many platelets do i give?

The typical platelets-only donation — called apheresis or singledonor platelets — collects between 300 billion and 600 billion platelets, less than a quarter of all the platelets in your bloodstream.

But don’t worry. Your bone marrow makes about 100 billion platelets a day, and in the typical 10-day period, all the platelets in your body are replaced anyway.

how many platelets are collected in a year?

There were 2.2 million units of platelets collected in the United States in 2013, according to the American Association of Blood Banks.

So how does my body make platelets?

Platelets actually are fragments of bone marrow cells called megakaryocytes. The megakaryocytes are too big to get into the bloodstream, but portions of them break off and are small enough to enter the bloodstream. Those broken-off pieces are platelets. A typical megakaryocyte produces about 1,000 platelets.

how big are platelets?

An unactivated platelet is between 2 and 4 micrometers (a micrometer is a millionth of a meter) in diameter.

If you have a difficult time thinking in terms either that small or that metric, here’s a different perspective: If you lined up 6,500 platelets, they would stretch from the knuckle of your thumb to the tip.

On the other hand, if you lined up all the platelets your body made in a day, it would be a very odd-looking line – and would stretch from San Antonio to the southern suburbs of Dallas. Yes, 400 billion micrometers is just about 250 miles. Ain’t math grand?

And even though there are lots of them, platelets make up less than 1 percent of the total volume of your bloodstream.

What do i need to do to get ready to donate?

Don’t take any aspirin or ibuprofen for at least 48 hours before your appointment, since they alter the way platelets work and make them pretty much ineffective. If you need something for aches and pains, use acetaminophen. If figuring out what acetaminophen is makes your head hurt, take two. (It’s the active ingredient in Tylenol.)

is it going to hurt?

The process is very similar to giving blood, with just the slight pinch of a needle and passing soreness in your arm. Side effects are pretty much the same as well, including minor tingling of the hands or mouth or a slight chill. visit us at www.bcms.org

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TRANSPLANTS & TRANSFUSION

Justin with his daughter Callie

A Good Samaritan to the very end

By Mike W. Thomas

Most every story of a successful, life-saving transplant begins with a heartbreaking story of tragic loss.

Huey said everything was in chaos for the next few moments as she called her husband, her daughter, Tiffany, and Justin’s father

For J.K. Huey, the story began on March 15, 2015 when she

whom she had divorced when he was a toddler). She called the hos-

learned that her son, Justin Bateman, had been critically injured in

pital as well, but they would not tell her anything about his condition

a motorcycle accident. The events of that tragic day were still fresh

over the phone.

in her mind nearly one year later as she recalled them.

Once at the hospital, Huey said the medical staff was kind and

Justin, 28, had left his house late the night before for a quick run

comforting, but just the look on their faces confirmed her worst fears.

to the store on his motorcycle. The next morning, Huey got a call

Justin had lost control of his bike and slammed into a retaining wall

from Tiffany, Justin’s fiancé, worried because he had not come home

at Wurzbach Parkway and Thousand Oaks. He suffered massive head

and was not answering her calls or texts. Huey went over to their

trauma and had been unresponsive from the time emergency person-

house and picked up Justin’s 4-year old daughter and took her to

nel arrived. They had him intubated and would leave him on life-

McDonald’s for breakfast and then her home, because Tiffany wasn’t

support for as long as the family wished, but a CAT scan had revealed

feeling well had her hands full taking care of their 9-month old son.

no brain activity or hope for recovery.

Shortly after she got home, the doorbell rang and she saw the sleeve patch of a policeman through the window.

The rest of that day and evening was a blur of family, friends and medical staff coming and going. Huey still tears up at the rec-

“My immediate thought was ‘Please let him be in jail,’” Huey said.

ollection of Justin’s father sitting at his bedside all that night. One

But the officer informed her that Justin was in the intensive care unit

person who came and spoke with her that afternoon was from the

(ICU) at San Antonio Military Medical Center or SAMMC. The of-

Texas Organ Sharing Alliance (TOSA). Justin had not registered

ficer had come to Huey’s house because that was the address that was

as a donor and it would be up to the family if they wanted to share

still listed on Justin’s driver’s license.

any of his organs.

16 San Antonio Medicine • April 2016

TRANSPLANTS & TRANSFUSION

J.K. Huey (center) with daughter Amy Gordon and son Justin Bateman.

“To me there was no question that Justin would want to do this,” Huey said. “It did not take long for the family to come together and make a joint decision.”

Radu holding Justin's son Carter.

“Radu is an amazing guy,” Huey said. “He said he was feeling incredibly lucky that night, but couldn’t help but think about the donor family.”

The transplant operation went remarkably well. Radu and his wife

We remained at Justin’s side throughout the night and the next morning, and he was pronounced dead that afternoon, March 16.

informed Huey that the doctors told them they did not even have to shock the heart to get it beating again once it was put in his chest

Just one month before the accident, Justin had become a minor

— which was a very good sign. In addition to the heart, they were

celebrity when he was featured on the local TV news after stopping

able to use Justin’s liver, kidneys, corneas and other skin and bone

to assist at another fatal traffic accident. Justin comforted a young

tissue to help many other transplant patients.

woman involved in a head-on collision as she took her final breaths, and he was later deemed a “Good Samaritan” by the local media.

“We were so glad that the heart was able to be used,” Huey said.

“And seven months after we lost Justin, I received a letter from TOSA

So Huey had no doubts that her son would want to continue help-

with the letter from Radu advising that he hoped to meet our family.

ing people even in death. And that decision gave new life and hope

A few weeks later, Radu and his wife came to our home to meet us

to another family.

for the first time. He told us that he will always take care of this

Radu (last name withheld by request) of Austin was in need of a new

heart and how blessed he feels to have it.”

heart and knew that his chances of getting one in time were slim. But he saw on the news a report about a “Good Samaritan” in San Antonio who had recently passed away. Shortly thereafter he was notified that there was a heart available. He put two and two together and told his family that he had a feeling he knew whose heart he was going to get.

Radu gave Huey a James Avery bracelet with two silver links held together by a heart of gold “I just cherish it,” Huey said. “I have worn it every day since.” visit us at www.bcms.org

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TRANSPLANTS & TRANSFUSION

UpdAtE ON “trEAtMENt ANd MANAGEMENt OF hEMAtOLOGiC MALiGNANCiES” hiGhLiGhtEd At 9th ANNUAL MEthOdiSt hOSpitAL CANCEr NEtWOrK CONFErENCE

By Paul Shaughnessy, MD, Medical Director, Adult Blood and Marrow Stem Cell Transplant Program Adult Blood Cancers and Stem Cell Transplant Physician, Methodist Hospital Methodist Hospital and the Texas Transplant Institute, a department of Methodist Hospital, and the Sarah Cannon Blood Network recently sponsored the Ninth Annual “Update in the Treatment and Management of Hematologic Malignancies: Highlights from Orlando,” review on Feb. 12 at the Oak Hills Country Club. Physicians and health care workers from San Antonio, Austin and the Rio Grande Valley who are involved in the care of cancer patients with hematologic diseases attended to participate and learn some of the latest updates in hematologic diseases.

The American Society of Hematology (ASH) put on their annual meeting in Orlando, Florida in December 2015, and over 30,000 hematologists and healthcare workers attended this premiere meeting for education and clinical updates in all aspects of hematology. Attending the ASH meeting in person can be difficult for those hematologists in private practice. The meeting itself is very large and covers many aspects of benign hematology. It also covers much focused areas of research that do not always pertain to the clinical practice of hematology. Therefore, Methodist Hospital, along with the Texas Transplant Institute and the Sarah Cannon Blood Network hosted worldwide experts in specific focused areas of clinical hematology to share highlights in these areas for hematologists and healthcare workers from throughout the Central and South Texas region.

The Ninth Annual “Highlights of ASH” included four experts in different areas of clinical hematology. Haydar Frangoul, MD, MS from The Children’s Hospital at TriStar Centennial Nashville, Tennessee presented updates in clinical advances and treatment of adolescents and young adults with hematologic cancers. Philip McCarthy, MD from Roswell Park Cancer Institute in Buffalo, New York, presented updates in the care of patients with multiple 18 San Antonio Medicine • April 2016

myeloma. Eric Jacobsen, MD from the Dana-Farber Cancer Institute in Boston, reviewed clinical advances in NHL/CLL and updates in treatment. Farhad Ravandi, MD from the University of Texas — MD Anderson Cancer Center in Houston presented information on the latest treatment options for patients with acute leukemia.

Total participants included 126 attendees, representing 101 providers including 62 physicians, 12 mid-Level providers (NP, PA), 24 registered nurses, two PharmDs, one social worker, and 25 other staff from Austin, the Hill Country, San Antonio area, and the Rio Grande Valley.

Over a few refreshments and a wonderful dinner at the Oak Hills Country club in a span of three and half hours, all attendees were able to hear world experts provide updates on the care of patients with these hematologic malignancies.

Participants received information on the latest treatment recommendations based on recent clinical studies presented at ASH 2015 for multiple myeloma, NHL, acute leukemias, and hematologic ma-

TRANSPLANTS & TRANSFUSION

lignancies in young adults. They learned how to identify the latest diagnostic and staging criteria for hematologic malignancies, and had the opportunity to discuss bone marrow transplant treatment for hematologic malignancies.

Having the opportunity to meet these experts face to face, as well as to mingle and greet our colleagues from the Central and South Texas area made for a very rewarding evening. CME was provided to all physicians and feedback on the speakers and topics of discussion was excellent.

Paul Shaughnessy, MD, Program Director, Blood and Marrow Stem Cell Transplant Program, Adult Blood and Marrow Stem Cell Transplant Physician Adult Blood and Marrow Stem Cell Transplant Physician Dr. Paul Shaughnessy’s interests center on the ability to closely follow transplant patients and the challenge of difficult medical situations. “Bone marrow transplant allows that great interaction between caring for patients and solving complex

clinical problems to improve outcomes in patients with hematological malignancies and those experiencing complications of bone marrow transplant,” says Dr. Shaughnessy. His research interests primarily involve bone marrow stem cell mobilization and improving outcomes in the treatment of graft-versus-host disease.

Dr. Shaughnessy received a Bachelor of Arts degree in biology and psychology from Indiana University, and a medical degree from Indiana University School of Medicine. He served his internship and residency in internal medicine at Wilford Hall Medical Center at Lackland Air Force Base, Texas. He then completed a fellowship in hematology-medical oncology also at Wilford Hall Medical Center. Dr. Shaughnessy is board certified in internal medicine, hematology, and oncology. He served as an assistant professor of medicine with the Uniformed Services of the Health Sciences from 1997 to 2001, and is a current assistant professor of Medicine at the University of Texas Health Science Center at San Antonio. He is a member of the American Society of Hematology, the American Society for Blood and Marrow Transplantation, as well as other professional organizations.

visit us at www.bcms.org

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TRANSPLANTS & TRANSFUSION

turning No into yes at the Nation’s Largest Living Donor Hospital Francis H. Wright, MD, FACS Methodist Healthcare System Organ Transplant Programs

”doctor, i have a kidney donor!” ... “i’m sorry, your donor is not a match.”

So begins another five or six year wait for a kidney transplant, along with more than 100,000 others in the United States. However, this also began the Kidney Paired Donation (KPD) program at Methodist Specialty and Transplant Hospital (MSTH) which has become the largest KPD experience of any hospital world-wide. It has helped the MSTH live donor kidney program to grow to the busiest in the U.S. since 2009, performing over 1,150 live donors and facilitating over 330 KPD transplants.

ABO or DSA incompatibilities are not always just yes-no situations and some level of incompatibility may be safely manageable and allow a transplant to proceed. Newer laboratory methods for detection and classification of antibodies are essential for managing living donation and KPD transplantation. A computer matching system is also needed for the several hundred persons that are in the MSTH KPD database awaiting a match. The matching process can be quite complex with multiple blood types and hundreds of antibody combinations.

“how would an exchange work, doctor?”

“Why am i not a match?”

There are two reasons for donor and recipient incompatibility: ABO blood type and immunologic incompatibility due to recipient antibodies directed against the donor. Both types can exist together.

ABO blood types for transplant are similar to transfusion, with type O being a universal donor. Donor specific antibodies (DSAs) responsible for incompatibility result from exposure to foreign, nonself antigens from pregnancies, previous transplants or prior blood transfusions.

20 San Antonio Medicine • April 2016

The simplest KPD exchange occurs when two donor-recipient pairs are ABO incompatible. For example, a B recipient with an A donor will not work and an A recipient with a B donor will not work.

But put the pairs into an exchange and A can donate to A and B to B so that both patients are transplanted. This type of swap may be extended to 3, 4 or more pairs. (See Figure 1 – page 22) Another type of exchange may begin with an altruistic, non-directed donor, i.e., someone who comes forward to donate a kidney to anyone. This may start a chain of transplants as shown in Figure continued on page 22

TRANSPLANTS & TRANSFUSION continued from page 20

2. The chain may end with a donation to someone on the transplant wait list. The longest chain done at MSTH involved 23 transplants, starting from one altruistic donor. Unfortunately these donors are not common as medical and other factors may rule out donation.

A summary of the KPD experience at MSTH is shown in Figure 3. Outcomes have been excellent and patients have achieved a transplant that had been waiting for as long as 14 years on dialysis. It has been extremely gratifying to be able to achieve transplants for these difficult patients who may have had little hope in the past.

There are other KPD programs in the U.S. and in other countries. The National Kidney Registry (NKR) based in New York has emphasized altruistic donors and transplant chains and was started by the father of a young girl who needed a kidney. The United Network for Organ Sharing (UNOS) which manages organ allocation and policy in the U.S. also has a KPD program open to all centers. The MSTH in-house approach has had advantages related to efficiency, flexibility and control that have made it uniquely successful. MSTH has also worked with the NKR, UNOS and other single center KPD programs to achieve transplants, exchanging donor kidneys with other programs in Texas and as far away as Georgia.

MSTH has been a leader in using compatible pairs to create exchange opportunities. In this type of case a donor-recipient pair is compatible and could proceed with a transplant — say an A recipient with an O donor. However the donor may not be the best age or size match, for example, and a better transplant may be possible in an exchange with an incompatible pair. This produces a win-win situation for both patients who receive transplants. It is important not to disadvantage the compatible pair and to not 22 San Antonio Medicine • April 2016

Figure 1

Figure 2

delay a possible transplant.

KPD was initially proposed in 1986 by Dr. Felix Rappaport. At that time swapping a kidney for another kidney was viewed as illegal under the National Organ Transplant Act of 1984 (NOTA). The Justice Department opined that an exchange was “valuable consideration” for an organ and therefore prohibited. The NOTA was amended in 2008 to specify that kidney exchange was legal and did not constitute “valuable consideration.” This allowed the MSTH continued on page 24

TRANSPLANTS & TRANSFUSION continued from page 22

program to begin in 2008.

The KPD program at MSTH has been directed by Adam Bingamin, MD, PhD. Cathi Murphy, PhD, who is laboratory director for Southwest Immunodiagnostics, has been an essential part of the program providing computer and histocompatibility services at a very sophisticated level. KPD exchanges may use up to six operating rooms and surgical teams running simultaneously and support from the transplant surgery and nephrology staff at MSTH along with consultants, nurses and administration has been essential. Of course it would not be possible without the support and consent of the real heroes: the living kidney donors and their recipients.

24 San Antonio Medicine • April 2016

Figure 3

BUSINESS OF MEDICINE

physician Compensation Arrangements

FRAUD ALERT

By Pamela C. Smith, Ph.D.

Several months ago you read my article on whether your bonus is ‘reasonable’ compensation. I focused on a Tax Court case where a medical practice could not deduct a bonus paid to its physician/owner. The premise of that article was to ensure you should never ignore the reasonableness of your compensation.

This concept of reasonable compensation is not merely a tax issue — it’s also a personal liability issue. As you are aware, the Anti-Kickback Statute may impose criminal penalties for efforts to induce or reward patient referrals covered by federal health insurance programs. Over the years, certain ‘safe harbors’ have been issued to allow providers alternatives to ensure compliance. The Office of the Inspector General (OIG) states “the ‘safe harbor’ regulations describe various payment and business practices that, although they potentially implicate the Federal anti-kickback statute, are not treated as offenses under the statute”.1 One such safe harbor is the ‘personal services and management exception’ — whereby providers (i.e. hospitals) can make compensation payments to physicians who can or do make patient referrals. Certain criteria are necessary for this safe harbor provision, including the payment must be based on the fair market value of the services, and the payment is not based on the volume of the referrals.

Given these established provisions in the law, what is new about this topic of compensation? Back in June 2015 the OIG issued a fraud alert, “Physician Compensation Arrangements May Result in Significant Liability”. This is one of the first OIG fraud alerts issued that directly impact physicians. What makes this OIG Fraud Alert unique is that it serves as notice for health care facilities and physicians to scrutinize compensation arrangements.

The Fraud Alert states “physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect the fair market value for bona fide services the physicians actually provide.” 2 The government

26 San Antonio Medicine • April 2016

agency also states that it reached settlements with twelve physicians for questionable arrangements. These cases alleged the payments to the physicians were not based on fair market value and the physicians did not actually provide the services outlined in the agreements.

You may be telling yourself that this has no impact on your personal situation. Keep in mind that this OIG Fraud Alert has caught the attention of hospital officials. Some industry consultants are reporting that this Alert can be a useful tool for hospital Chief Financial Officers (CFOs) in negotiating compensation arrangements with physicians. You are now asking “why would CFOs want to use this in negotiations?” Answer: the Fraud Alert speaks to negotiations — “OIG encourages physicians to carefully consider the terms and conditions of medical directorships and other compensation arrangements before entering into them”. 3 Even though the Fraud Alert mentions physicians directly, hospitals and other providers are taking notice, and may even go back to review existing arrangements to ensure compliance.

This OIG Fraud Alert served as a catalyst for discussion of what is deemed reasonable compensation. The agency is also looking to hire more attorneys to investigate the issue. It is possible that more action will be taken against individual physicians, rather than organizations. Investigations of compensation arrangements will not go away, so physicians and health care providers must be proactive and aware to ensure the arrangements are compliant.

rEFErENCES 1 http://oig.hhs.gov/compliance/safe-harbor-regulations/ 2 http://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf 3 Ibid.

Pamela C. Smith, PhD, is a professor in the department of accounting at the University of Texas at San Antonio.

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27

NON PROFIT

40 Years of Saving Lives in Central & South Texas Starting with seven physicians in 1975 who had a vision, to using

“We’re adapting to telemedicine and the Internet and it gives us the capability of sending images and video at any time of day. We are being more efficient and make more offers in a short amount of

telecommunication to asses a po-

time,” explained Joseph Nespral, TOSA’s senior director of clinical

tential donor in 2015, at Texas

then it was one call at a time.”

Organ Sharing Alliance (TOSA), formally South Texas Organ bank, the goal has always been the same: optimize the opportunity to save lives through organ donation.

In TOSA’s 40 years, the most

services. “That would have been impossible a few years ago. Back Likewise, medical technology has made the process of managing donors much smoother. Additional and more precise testing has allowed for a clear understanding of organ function and has aided in identifying any potential transmittable diseases.

“Years ago it was a race to get to the OR,” said Nespral, an 18-year veteran with TOSA. “Now we can take a deep breath and stabilize the donor to place organs.”

Mike Rosson, a former regional director for TOSA’s Austin office whose experience spans to the first donor in El Paso in 1973, said TOSA’s hospital development staff have made great strides in earning

dramatic and palpable ways to see

the trust of hospital staff to allow TOSA to fulfill its mission. Hospital

how donation has changed is how

for cooperation in the donation process.

technology has become vital to saving lives.

development staff are tasked with educating nurses about the need “We show up when we said we will and the families will be treated well,” said Rosson. “We gained their confidence – that’s a big deal.”

Along with educating hospital staff, public education has normalized the donation conversation.

28 San Antonio Medicine • April 2016

NON PROFIT

“It took time for that to really take off,” Rosson said, “but it’s been a major contribution.”

TOSA’s 40 years of community education have saturated Central and South Texas, making it difficult to find someone who doesn’t know about organ donation.

“Forty years ago a lot of people didn’t know what this was about,” said Nespral. “It’s a well-known procedure now and there’s a chance you know someone who has benefited from a transplant.”

Both men agree that the creation of Donate Life Texas, the state’s official registry for organ, eye and tissue donors, has been the chief milestone for TOSA. “By far it’s the biggest development that has occurred over the years,” Nespral said.

While TOSA’s first registered donor was an out-of-state donor nearly 10 years ago, Nespral remembers it being an exciting time for the organization. Now, with the establishment of Donate Life Texas, TOSA has started to see a shift in activity with registered donors.

“We started off slow, but now we’re seeing a constant number of registered donors,” he said. “We have room to grow, which is good.”

Donate Life Texas allows donors to make the decision on their own, ensures their wishes are carried out and eases the burden off families.

“It’s tremendous,” Rosson said of the registry. “Nothing I did is more challenging than talking to the family; that’s a difficult task.

Top photo: Organ recovery coordinators Edda Karam and Evelio Matos. Bottom photo: TOSA coordinator in OR.

Now we have this widespread acceptance with people on the registry and families not having to make the decision. It’s been huge. It’s becoming the norm.”

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29

LIFESTYLE

Heavy Medal

By Carole Miller, Article Courtesy of the Paseo Del Rio Association

Sure there are a plethora of parades, countless kings and queens and more foodon-a-stick than you can shake a stick at, but every Fiesta fanatic worth his or her cascarones knows that the goal during Fiesta is to collect and wear as many medals as you possibly can, usually pinned all over their specially-designed sashes and hats.

30 San Antonio Medicine • April 2016

LIFESTYLE

If you are into this kind of “heavy medal,” rock on over to Alamo Plaza for Pin Pandemonium, THE place to find whatever and whoever you want to find. During this annual, free Fiesta kickoff event, anyone and everyone who collects pins and medals gathers to view, buy and trade these precious medals and enjoy the opening ceremonies of Fiesta Fiesta. Some ultra-creative medals feature designs with moving parts, 3D effects, sparkling colors and even LED lighting. This year’s Pin Pandemonium takes place Thursday, April 14, at 6 pm in Alamo Plaza.

According to the Fiesta Commission, there are 17,000 medals sold at The Fiesta Store on Broadway (the “official” Fiesta store) alone. But there are more medals produced than you can count.

Medal producers include charitable organizations, colleges and universities, hotels, restaurants, sports, events, churches, city areas and attractions, banks, doctors, judges and attorneys. Highly collectible medals include those from the district attorney, mayor, police chief and fire department.

Original Medal Head King Antonio XLIX Charles Orsinger gets the historical nod for “inventing” the Fiesta medal. During his reign over Fiesta in 1971, His Royal Highness punched holes into his royal coins, strung them with ribbon and handed them out to his loyal subjects that year. Today, all the Fiesta royalty give out

their own individually-designed pins and many organizations sell their own as fundraisers. Businesses highlight their brands via pins and some individual Fiesta fanatics even make their own. Some ultra-creative medals feature designs with moving parts, 3D effects, sparkling colors, and LED lighting.

One of San Antonio’s premier medal makers is FiestaMedals.com. It started as the brainchild of Lt. Col. Leon Childers (ret.) who, in the late 70s, created the first militarythemed Fiesta medal for the Commanding General to hand out during Fiesta events.

Nowadays, anyone with an imagination and an internet connection can make their own Fiesta medal since medals can now be designed and ordered online. There are many local manufacturers and they estimate that the number of medals made over the years runs in to the hundreds of thousands. Back in the olden days, customers would come in with a design or idea and it would be drawn by hand. (That part is done by computer now.) After the medal is designed, the factory makes a model, die, stamp, fills it with color, assembles the ribbons and adds dangles or any extras.

Metal detectors unite! The unique traditions of Fiesta medals bring an extra factor of frivolity and folly to this festival of fanciful fun. So come and join the revelry. What do you want—a medal? visit us at www.bcms.org

31

MEDICARE

Grandma and her Medicare

By Jeffrey Pyle, Alamo Area Council of Governments

Grandma had to go to the doctor the other day for her usual follow up appointment.

She has had diabetes and high blood pressure for many years. The doctor said she was doing good, to keep up the good work, and renewed her prescriptions.

While Grandma feels good physically, she worries about her medical costs. Since it is the beginning of the year, not only does she have to pay the part B premium of $104.90, but also the deductible of $147, and then she has to pay the 20 percent coinsurance which is $24 for the doctor visit.

The stand-alone part D prescription drug coverage plan she selected covers the two drugs she needs: Levemir Flextouch for her diabetes and Diltiazem to handle her high blood pressure and the minor angina she experiences. Unfortunately, the plan doesn’t cover the brand name version which helped her better than the generic.

The plan has a premium of $42 per month and she has to pay at least $38 per prescription refill; that will change when she hits the coverage gap requiring her to pay 65 percent of plan costs for her prescriptions. Thankfully, she does not have a deductible on this plan.

All of this got too confusing for her, so she called me over to help sort all this out.

So, I checked to see what she is living on every month. I found she lives on a Social Security check of $1,234. This means that she paid $355 for her health costs this month, leaving only $879 to pay the rest of her expenses. Her rent is $455 per month and her groceries are about $200, so that leaves $255 to cover all the bills and whatever else she might need like clothes or the things she likes to buy for the grandkids.

My eyes bulged out. I couldn’t believe she was living like this. Not

32 San Antonio Medicine • April 2016

every month is like this, thankfully, because the deductible is a onetime thing. But, wow, she is in real danger when that coverage gap hits or she has some emergency. It would be catastrophic to end up in the hospital. I mean, she has some savings but nothing to cover being in the hospital.

So, I decided to start looking around and see what there might be to help her. Someone recommended I call the local area agency on aging. I called and explained the situation and how worried I am.

They said there are Medicare Savings Programs and Extra Help Programs for low income seniors that will help pay those Medicare costs for them.

If you are between 135 percent and 100 percent of the poverty level — which in 2015 is $1,345 to $1,001 — there are funds to pay the premium for that Medicare beneficiary. If one makes less than $1,001, then basically all the costs, including the coinsurance and deductibles are paid. The same goes for the Extra Help which will provide a subsidy for those between 150 percent and 100 percent of poverty and for those below 100 percent, it will pay for deductibles and copays (unfortunately it does not cover that coverage gap).

Well, I tell you, that was such good news. We got Grandma signed up: so now, she will get to save at least $150 per month. She feels much better because now she has a little more wiggle room in her costs. Now, I tell everyone I can about these programs so that my friends’ grandmothers can get the help they so richly deserve.

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33

BOOK REVIEW

thiS OLd MAN By roger Angell

Reviewed by Fred H. Olin, M.D.

I don’t buy many physical books: 50 plus years of accumulating miscellaneous volumes have pretty much filled up our shelves, and then some, so I limit myself to what I can borrow from the library or read on my Kindle. A couple of months ago, as I drove up Babcock Road on my way to the Igo branch library, I heard an interview with Mr. Angell on Texas Public Radio, and was fascinated. I got the book from the library and read it…and promptly ordered it from Amazon.

First, who is Roger Angell? He’s been a newpaper baseball writer in New York and has written several books about baseball. He’s been a New Yorker Magazine fiction editor and writer. He’s the only writer elected to membership in both the Baseball Hall of Fame and the American Academy of Arts and Letters. He’s in his mid-90s, widowed, has a fox terrier named Andy, and seems to be able to write about anything. Perhaps that is explained by the fact that his mother was the fiction editor of the New Yorker and his father was E.B. White, the author of “Charlotte’s Web,” “Stuart Little” and co-creator of Strunk and White’s “Elements of Style.” Who knows if it was “nature or nurture” that produced Roger Angell? It’s not important.

What is important is that we have had him here for us to appreciate.

Now, about the book: it’s a collection of Angell’s stuff, and “stuff ” is an intentionally ambiguous term. There are essays, letters, poems both comic and serious, memories and memoirs, and a libretto for an all-dog opera. He (or his editors at Doubleday) have included a couple of fairly long critical pieces about books and authors, including one about Vladimir Nabokov’s, “Lolita.” It’s not what you might expect, if all you think about is the lurid, pedophilic aspect of that book. It’s a literary analysis that, I must admit, revised my vague but somewhat, umm, “racy” memories of reading the book back in the early ‘60s.

The centerpiece of the book (actually, it’s quite close to the end) is

34 San Antonio Medicine • April 2016

the award-winning essay “This Old Man.” It is a discussion of the essay that I heard while driving that day and that stimulated all of this. I’ve re-read it almost compulsively, because he says things I’ve sort of conceptually thought about but never tried to put into words.

Why should you read this book, you ask? Certainly not because I recommend it, although I most definitely do. You should read it so that you can appreciate one of the most interesting and facile American writers ever. As always, I can’t do as well as the professional critics. Indulge me and read this excerpt from the review in the Sunday New York Times. It says what I would like to have been able to say: “…he has put together one last (one assumes) collection of odds and ends: essays, urban sketches, letters, Christmas jingles and dog haiku, farcical opera librettos, elegies, tributes, literary criticism, baseball reporting — the whole schmear. He himself describes it as “a mélange, a grab bag, a plate of hors d’oeuvres, a teenager’s closet, a bit of everything.” Some of the writing is terrific, some very slight.

Is it modesty, vanity or both that has prompted the author to include the weak with the strong, the trivial with the pungent, so that readers may get a chance to see him in all his moods and musings?

Whichever the case, not only is no harm done, but there is a certain generosity operating here, an assumption of friendship between reader and writer, the way one is pleased to hear what a friend has to say no matter what the occasion. In inviting us to rummage through his literary files, Angell proves almost consistently engaging and companionable.

And THAT’S why you should read this book. There will be a test later, so get after it!

Fred H. Olin, M.D. is a semi-retired orthopaedic surgeon who is about 18 years younger than Roger Angell, but still related to the essay that shares the title with the book.

visit us at www.bcms.org

35

FINANCIAL HEALTH

CAN FINANCIAL STRESS AFFECT MY HEALTH?

By Abbey Carnes, Ozona Bank

36 San Antonio Medicine • April 2016

The Federal Reserve has increased interest rates for the first time since the 2008 financial crisis began. The unemployment rate is at an all-time low in nearly eight years at 5 percent.

Gas prices have fallen below $2.00 in forty one states. Yet we are still financially stressed.

Whether you have a large amount of student debt, lost your job, or you’re simply irresponsible with your money, you are the majority. According to a 2015 survey conducted by Financial Finesse, 85 percent of Americans experience stress related to income, retirement planning, paying bills on time, and not having control of their financial destiny. In fact, only 19 percent of men and 7 percent of women earning less than $60,000 in 2014 felt financially stress free. On the other end of the spectrum, only 22 percent of men and 15 percent of women earning more than $100,000 reported being financially stress free, which tells us that financial stress effects everyone regardless of income level.

Just as there are many causes of stress, there are many reactions to stress, both immediate and long- term. For example, when you’re under stress your body experiences immediate short-term effects, such as faster breathing, increased heart rate and blood pressure, memory and concentration suppression, release of cortisol, and a reduction in metabolism. In the long-term, stress is known to increase the risk of heart disease, stroke, digestive problems, and sexual dysfunctions, just to name a few. Furthermore, it can lead to unhealthy weight gain or loss, skin problems, sleep issues, increased pain and the aggravation of chronic diseases like diabetes.

In addition to the physiological effects, the psychological effects can lead to a symbiotic cycle of cause and effect. Chronic financial stress can lead to poor performance at work due to external distractions and frequent absences to visit the doctor, which in turn can lead to a demotion or worse—termination. Obviously, this would contribute to further financial stress impacting your relationship with your family, and potentially change your lifestyle. continued on page 38

FINANCIAL HEALTH continued from page 36

Your home life is not safeguarded from financial stress either. More often than not, your family bears the brunt of the majority of stress because you feel most comfortable with them. You’re more likely to discuss financial strife with your wife or husband than you would with a friend or colleague and this type of discussion opens the door for potential disagreement and a source of tension between partners.

In fact 35 percent of respondents in a SunTrust Bank survey reported that finances were the leading cause of stress in their relationship.

Stress Management One of the best ways to reduce financial stress is to select a reputable and sound financial institution that truly fits your needs. For example, consider the legitimacy and longevity of the bank when making your selection as well as their FDIC coverage. When the United States’ largest savings and loan association collapsed in 2008, Washington Mutual customers were covered up to the FDIC maximums regardless of the Chapter 11 filing by the bank because they were insured by the FDIC. You can use the BankFindTool at FDIC.gov to research the current coverage of any financial institution.

While technological advances such as Remote Deposit Capture and Mobile Banking have reduced the need to have a traditional branch nearby, if you are considering a business loan, a first mortgage, a line of credit, or another service beyond your typical deposit needs, you would likely need to be able to discuss your options face-to-face with an experienced banker. Look for a banker who has considerable experience in your market area and your product type. For example, Lydia Gonzales of Ozona Bank has more than 20 years in the banking industry in the San Antonio area. Her focus on commercial businesses such as medical groups, engineering firms, real estate agencies, and software groups makes Lydia the ideal banker if you are in these 38 San Antonio Medicine • April 2016

corridors of the market. In addition to the experience she brings to the table, Ozona Bank offers one-on-one services paired with all the innovative offerings you would find in a big bank.

Investing in your future is just as important as your immediate financial needs. Look for a bank that covers all your needs including investment services. Shane Cooper of Cetera Investment Services, LLC* offers the added advantage of conducting all of your banking, investment, and insurance activities in one location. Having all these services available to you in one stop will help reduce the stress of maintaining several appointments in several different locations. Just like Lydia navigates the banking world, Shane too walks investors through the choices available to save for retirement, preserve your wealth, and create lifetime income solutions—all of these can help with your financial future.

Just as if you were in search of a doctor, you would consider their credentials and experience—this is the same in the banking industry.

Manage your stress one step at a time. Develop a routine with a healthy diet, regular exercise, and build a roster of financial professionals that can guide your decisions to help reduce your financial stress. All these steps combined can help mitigate the effects of financial pressure and break the cycle of health risks associated with financial stress. *Securities and insurance products are offered through Cetera Investment Services LLC, member FINRA/SIPC. Advisory services are offered through Cetera Investment Advisers LLC. Neither firm is affiliated with the financial institution where investment services are offered. Investments are: *Not FDIC/NCUSIF insured *May lose value *Not financial institution guaranteed *Not a deposit *Not insured by any federal government agency. Located at: 14100 San Pedro Avenue Suite 100, San Antonio, TX 78232 (210)-319-3500

BCMS NEWS

BExAr COUNty MEdiCAL SOCiEty BUiLdiNG NAMEd 2015 ASA prOjECt OF thE yEAr The Bexar County Medical Society's new building at 4334 N. Loop 1604 West in Shavano Park has been named the 2015 Project of the Year in the $2.5 million to $5 million category by the American Subcontractors Association - San Antonio Chapter.

The award was presented during a banquet on March 10, 2016 at the Pearl Stable.

The building is situated on North Loop 1604 West between Lockhill Selma & Northwest Military. This two story, 20,000 s.f. class "A" office building, built by R.C. Page Construction, features a mix of old Spanish style architecture with a modern twist.

Special features include a grand staircase with mahogany woodwork, marble tile lobby flooring, mahogany bookcases and millwork throughout the space, and a board room that looks out onto the Texas Hill Country through a 2nd floor glass archway. Like the building that it was modeled after, the Alamo, the BCMS building will be an iconic piece of architecture on the North Loop for many years to come.

The Bexar County Medical Society, established in 1853, is the oldest county medical society in Texas, with a membership of approximately 4,700 physicians in all specialties. Its mission is to advocate for physicians and great patient care in both San Antonio and Bexar County. visit us at www.bcms.org

39

BCMS NEWS

40 San Antonio Medicine • April 2016

BCMS NEWS

visit us at www.bcms.org

41

UTHSCSA DEAN’S MESSAGE

UT School of Medicine Dean’s Update: UT MEDICINE HILL COUNTRY TO SERVE FAIR OAKS RANCH/BOERNE/LEON SPRINGS

By Francisco González-Scarano, MD

On January 13th, we held a groundbreaking ceremony to launch the construction of our newest satellite office for UT Medicine. The location, 25723 Old Fredericksburg Road, is approximately half way between Boerne and San Antonio. (One half mile north of Ralph Fair Road on the east side of Interstate 10.) This facility, scheduled to open in spring of 2017 will comprise approximately 19,000 square feet.

Services at the new location will include primary care, orthopaedics, radiology, physical therapy, urology and lab services, as well as other services on a scheduled rotation. Features include a full-service imaging center with magnetic resonance imaging (MRI), CT scanner and digital X-rays. Look for more information as we get closer to opening next year.

interactive Academic Learning & teaching Center Opens On February 16th we dedicated our new “Academic Learning & Teaching Center” (ALTC), a building that features classrooms with the latest technology in virtual and actual medical education.

The 130,000-square-foot building features more than 33 ultramodern classrooms and strategic learning spaces, and a state-of-theart digital anatomy laboratory with 3-D interactive imaging capabilities. This facility does not replace but enhances traditional medical school (and other health profession schools) cadaver dissection.

Students may be watching a heart surgery in real time in one classroom while in another classroom students are using virtual technology to study the anatomy of the heart via CT scans. The classrooms are designed to support our new curriculum structure as well, where dynamic meeting spaces focus on discussion-based exploration and learning.

The ALTC digital anatomy lab educational experience is equipped with a digital visualization system that allows: 42 San Antonio Medicine • April 2016

Faculty, fellows, residents and students to import a patient’s data (CT scans and MRI images of normal and diseased anatomy) and view that in 3-D. Manipulation of the anatomical images using a video controller; students can rotate images, zoom in and out, filter for certain tissues, and generate virtual cross-sections in any plane.

Projection of images onto screens in the lab, where students can view the images in 3-D using goggles that add depth to what they are seeing.

ALTC classrooms range in size from a room the area of a football field that can accommodate 280 students, to seminar rooms that seat 12-18 persons. Unique to this new teaching environment is that the classroom is not linear (front and back)– it is an integrated space linked by technology. Even the furniture design encourages and enhances learning and discussion, with table tops in the student lounging areas that also serve as dry-erase boards for drawing and

UTHSCSA DEAN’S MESSAGE

formation or to refer a patient please call the CTRC clinical study line at 210-450-5798.

pediatric tumors and Lymphoma

explaining. It also includes “Panorama”, a restaurant with great views of the city and northern hills, to serve faculty, staff and students of the Health Science Center and their guests.

We were honored to welcome San Antonio Mayor Ivy Taylor, and Bexar County Judge Nelson Wolff at the dedication. Sara Martinez Tucker, a member of The University of Texas System Board of Regents, accepted the building on behalf of the Regents and ceremonially turned it over to UT Health Science Center President William Henrich, MD.

First in U.S. Cancer trials We currently have two very significant cancer trials for which we are the first-in-human study site in the United States. One is for adult brain tumors and the other for pediatric solid tumors and lymphoma. These trials are very recent innovations and actively seeking new patients. A brief description of each is below. Please contact the research team if you would like to learn more or refer a patient.

Adult Glioblastoma The technology, developed at the Cancer Therapy & Research Center (CTRC), uses tiny radioactive liposomes (fat particles 100 nanometers in diameter), inserted by catheter directly into a tumor, confining their radiation to the tumor tissue only.

The trial is protocol number HSC20140450X; Title: “A Dual Phase 1/2, Investigator Initiated Study to Determine the Maximum Tolerated Dose, Safety, and Efficacy of Rhenium Nanoliposomes (RNL) in Recurrent Glioblastoma (CTRC# 12-02).” For more in-

The new clinical trial with the drug atezolizumab will be offered to children ages 2 to 17 and young adults up to age 30 who have pediatric cancers. The focus will be on solid tumors and two types of lymphomas (Hodgkin lymphoma and Non-Hodgkin lymphoma).

Based on results from several clinical trials in adults, the U.S. Food and Drug Administration in February granted Breakthrough Therapy Designation for atezolizumab for treating non-small cell lung cancer in adults. Atezolizumab also has shown good results against a type of bladder cancer called metastatic urothelial carcinoma. The drug is also being tested with numerous other types of cancer in adults. This trial is “A Single-Arm Study to Evaluate the Safety, Tolerability, Pharmacokinetics, Immunogenicity, and Preliminary Efficacy of MPDL3280A (Anti-PD-L1 Antibody) in Pediatric and Young Adult Participants With Solid Tumors.” For more information on eligibility and how to participate, contact Virginia Diaz at diazvr@uthscsa.edu or 210-562-9149.

rare & historical Anatomy Book display – April 12, 3-6pm Our P.I. Nixon Medical Historical Library will be holding an exhibit of rare and historical anatomy texts. View a first edition of De Humani Corporis Fabrica Libri Septem, by Andreas Vesalius, published in 1543, and a 1481 edition of De Medicina by Aulus Cornelius Celsus, the Nixon Library’s oldest book. The display is open to the public.

Featured Speaker New York Times best-selling author, Damon Tweedy, M.D., will talk about his book “Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine”, Tuesday, April 19, 2016 in the Holly Auditorium. Dr. Tweedy is a graduate of the Duke University Medical School as well as Yale Law School. He is an assistant professor of psychiatry at Duke University Medical Center and a staff physician at the Durham VA Medical Center. His book was selected as one of TIME Magazine’s top 10 non-fiction books of 2015. Presentation begins at 12 noon followed by a 1 p.m. reception and booksigning. Presented as part of the Frank Bryant Jr., M.D., Memorial Lectures in Medical Ethics. continued on page 44 visit us at www.bcms.org

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UTHSCSA DEAN’S MESSAGE continued from page 43

Grand rounds There are Grand Rounds held every day of the week in the School of Medicine. They are held at different hours, from 7am to after 5pm. Most are open to community physicians and provide one hour of Continuing Medical Education Credit. The current list is below, however changes occur often. You can also contact our Continuing Medical Education office at 210-567-4491.

• Family & Community Medicine: Wednesdays; 12:30pm – 1:30pm; Robert B. Green campus; UHS Board Room 5th floor; 210-567-4556 • Gastroenterology & Human Nutrition Didactic and Case Conference: Thursdays; 2:00pm – 4:00pm, School of Medicine 444B; 210-567-4879 • General Surgery: Mondays; 7:00am – 7:45am; School of Medicine 409L in the fall, 309L in the spring; 210-567-1613 • Nephrology: Wednesdays; 4:00pm – 6:00pm; Dental School Building, 5.330T; 210-567-4700 • Neurological Sciences: Fridays; 8:00am – 9:30am; School of Medicine 309L; 210-450-0538 • OB/GYN; Wednesdays: 12:30pm – 1:30pm; School of Medicine: 409L-410L; 210-567-4930

44 San Antonio Medicine • April 2016

• Orthopaedic Surgery: Mondays; 7:00am – 8:00am; School of Medicine 409L; 210-567-5125 • Pediatric Cardiology/Cardiothoracic Surgery Case Management Conference: Mondays; 7:30am – 9:00am: UHS Sublevel Cardiac Cath Conference Room; 210-562-5113 • Pediatrics: Fridays; 7:30am – 8:30am: School of Medicine 409L; 210-567-4298 • Podiatry: Wednesdays; 6:30am – 8:30am; School of Medicine 444B; 210-567-5174 • Psychiatry: Tuesdays; 1:15pm – 2:30pm; School of Medicine 409L; 210-567-5492 • Transplant: Fridays; 8:00am – 9:00am; School of Medicine 444B: 210-567-5771 • Vascular Surgery: Tuesdays; 6:45am – 8:00am; School of Medicine 221E; 210-567-5715

important dates Match Day; Friday, March 18, 2016 MD Graduation; Saturday, May 22, 2016; 2pm Francisco González-Scarano Dean, School of Medicine Executive Vice President for Medical Affairs University of Texas Health Science Center San Antonio John P. Howe, III, MD, Distinguished Chair in Health Policy Professor of Neurology.

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.

ACCOUNTING FIRMS Padgett Stratemann & Co., LLP (HH Silver Sponsor) Padgett Stratemann is one of Texas’ largest, locally owned CPA firms, providing sophisticated accounting, audit, tax and business consulting services.

Vicky Martin, CPA 210-828-6281 Vicky.Martin@Padgett-CPA.com www.Padgett-CPA.com “Offering service more than expected — on every engagement.”

Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets.

Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

BANKING

BBVA Compass (HHHH 10K Platinum Sponsor) Our healthcare financial team provides customized solutions for you, your business and employees.

Commercial Relationship Manager Zaida Saliba 210-370-6012 Zaida.Saliba@BBVACompass.com Global Wealth Management Mary Mahlie 210-370-6029 mary.mahlie@bbvacompass.com Medical Branch Manager Vicki Watkins 210-592-5755 vicki.watkins@bbva.com Business Banking Officer Jamie Gutierrez 210-284-2815 jamie.gutierrez@bbva.com www.bbvacompass.com “Working for a better future.”

Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great rela-

46 San Antonio Medicine • April 2016

tionship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things.

Jeanne Bennett 210- 343-4556 jeanne.bennett@amegybank.com Karen Leckie 210-343-4558 karen.leckie@amegybank.com www.amegybank.com “Community banking partnership.”

BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance — BB&T offers banking services to help you reach your financial goals and plan for a sound financial future.

Chris Sherman 210-247-2978 csherman@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community.

Ken Herring 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com “We’re here for good.”

Frost (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Lewis Thorne 210-220-6513 lthorne@frostbank.com www.frostbank.com “Frost@Work provides your employees with free personalized banking services.”

IBC Bank (HHH Gold Sponsor) IBC Bank is a $12.4 billion multibank financial company, with over 212 facilities and more than 325 ATMs serving 90 communities in Texas and Oklahoma. IBC BankSan Antonio has been serving the Alamo City community since 1986 and has a retail branch network of 30 locations throughout the area.

Markham Benn 210-354-6921 MarkhamBenn@ibc.com www.ibc.com “Leader in commercial lending.”

Ozona Bank (HHH Gold Sponsor) Ozona National Bank is a full-service commercial bank specializing in commercial real estate, construction (owner and non-owner occupied), business lines of credit and equipment loans.

Lydia Gonzales 210-319-3501 lydiag@ozonabank.com www.ozonabank.com

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Brandi Vitier 210-807-5581 brandi.vitier@ thebankofsa.com www.thebankofsa.com

SSFCU (HHH Gold Sponsor) Founded in 1956, Security Service provides medical professionals with exceptional service and competitive rates on a line of mortgage products including one-time close construction, unimproved lots/land, jumbo and specialized adjustable-rate mortgage loans.

Commercial Services Luis Rosales 210-476-4426 lrosales@ssfcu.org Investment Services John Dallahan 210-476-4410 jdallahan@ssfcu.org Mortgage Services Glynis Miller 210-476-4833 gmiller@ssfcu.org Bank of America (HH Silver Sponsor) Bank of America provides people, companies and institutional investors the financial products and services they need to help achieve their goals at every stage of their financial lives.

Jennifer Dooling 210-270-5226 jennifer.dooling@baml.com Courtney Martinez 210-419-2643 courtney.martinez@baml.com http://about.bankofamerica.com/ en-us/index.html Making financial lives better — one connection at a time Firstmark Credit Union (HH Silver Sponsor) Address your office needs: Upgrading your equipment or technology • Expanding your office space • We offer loans to meet your business or personal needs.

Competitive rates, favorable terms and local decisions.

Gregg Thorne SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org Generations Federal Credit Union (HH Silver Sponsor) Generations provides a wide array of innovative products including

BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY loan, deposit and investment solutions for personal and commercial banking needs.

Yvonne "Bonnie" M. Aguilar 210-229-1800 bonnie.aguilar@ mygenfcu.org www.mygenfcu.org “For this generation and the next.”

terior finish-out projects. Services include conceptual and final pricing, design-build and construction management. Single-source management from concept to completion ensures continuity through all phases of the project.

Clay Page 210-375-9150 clay@rcpageconstruction.com

RBFCU (HH Silver Sponsor) 210-945-3800 businesslending@rbfcu.org www.rbfcu.org

ELECTRONIC DOCUMENTATION AND TRANSCRIPTION SERVICES

BIOMEDICAL WASTE DISPOSAL

BioMedical Waste Solutions, LLC (HHH Gold Sponsor) Save costs on your medical waste disposal! BioMedical Waste Solutions provides a compliant, reliable and low-cost service.

Wes Sonnier 1-877-974-1300 Wes@BioMed-Disposal.com Joe Loyacano 1-877-974-1300 Joe@BioMed-Disposal.com www.BioMedicalWasteSolutions.com “BCMS members save 10 percent off or one free month! Request a free quote in 10 seconds at www.BioMedicalWasteSolutions.com.”

CONTRACTORS/BUILDERS/ COMMERCIAL

Huffman Developments (HHH Gold Sponsor) Premier medical and professional office condominium developer.

Our model allows you to own your own office space as opposed to leasing.

Steve Huffman 210-979-2500 Shawn Huffman 210-979-2500 www.huffmandev.com

RC Page Construction, LLC (HHH Gold Sponsor) Commercial general contractor specializing in ground-up and in-

Med MT, Inc. (HH Silver Sponsor) Narrative transcription is physicians’ preferred way to create patient documents and populate electronic medical records.

Ray Branson 512-331-4669 branson@medmt.com www.medmt.com “The Med MT solution allows physicians to keep practicing just the way they like.”

ELECTRONIC MEDICAL RECORDS

Greenway Health (HHH Gold Sponsor) Greenway Health offers a fully integrated electronic health record (EHR/EMR), practice management (PM) and interoperability solution that helps healthcare providers improve care coordination, quality and satisfaction while functioning at their highest level of efficiency.

Stacy Berry 830-832-0949 Stacy.berry@greenwayhealth.com www.greenwayhealth.com

EMPLOYEE BENEFITS

e-ESI (HHH Gold Sponsor) Locally owned since 1999, we believe it's all about relationships. We keep our partners compliant assisting with human resource administration/management, workers' compensation/risk management, benefit administration, and payroll. We help our partners concentrate on what they do best...Service their customers.

Lisa Mochel (210) 495-1171

lmochel@eesipeo.com www.eesipeo.com

FINANCIAL SERVICES

Northwestern Mutual Wealth Management (HHHH 10K Platinum Sponsor) Our mission is to help you enjoy a lifetime of financial security with greater certainty and clarity. Our outcome-based planning approach involves defining your objectives, creating a plan to maximize potential and inspiring action towards your goals. Feebased financial plans offered at discount for BCMS members.

Eric Kala, CFP, AEP, CLU, ChFC Wealth Management Advisor Estate & Business Planning Advisor 210-446-5755 eric.kala@nm.com www.erickala.com "Inspiring Action, Maximizing Potential"

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life.

Jeffrey Allison 210-268-1530 jallison@ aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

Frost Leasing (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Laura Elrod Eckhardt 210-220-4135 laura.eckhardt@frostbank.com www.frostbank.com “Commercial leasing for a doctor’s

business equipment and vehicle.”

Bob Davidson New York Life (HH Silver Sponsor) Dedicated agent at New York Life helping physicians and medical professionals achieve their financial dreams.

Bob Davidson 210-321 1445 rdavidson02@ft.newyorklife.com www.linkedin.com/in/bobdavidsonnyl “Taking care of those who take care of us.”

HEALTHCARE REAL ESTATE

San Antonio Comercial Advisors (HHH Gold Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”

HIPAA COMPLIANCE SERVICES Cyber Risk Associates (HH Silver Sponsor) Cyber Risk Associates provides HIPAA compliance services designed for small practices, offering enterprise-quality privacy and security programs, customized to your needs.

David Schulz 210-281-8151 DAS@CyberRiskAssociates.com www.CyberRiskAssociates.com

HIPAA/MANAGED IT/ VOIP/SECURITY

Hill Country Tech Guys (HHH Gold Sponsor) Provides complete technology services to many different industries, specializing in the needs of the financial and medical industries. Since 2006,

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 47 our goal has always been to deliver relationship-based technology services that exceed expectations.

Whit Ehrich, CEO 830-386-4234 whit@hctechguys.com http://hctechguys.com/ “IT problems? Yeah… we can fix that!”

HOSPITALS/ HEALTHCARE SERVICES

Southwest General Hospital (HHH Gold Sponsor) Southwest General is a full-service hospital, accredited by DNV, serving San Antonio for over 30 years. Quality awards include accredited centers in: Chest Pain, Primary Stroke, Wound Care, and Bariatric Surgery.

Business Development Director Blake Pollock 210-243-9151 bpollock@iasishealthcare.com www.swgeneralhospital.com "Quality healthcare with you in mind."

Warm Springs •Medical Center •Thousand Oaks •Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research.

Central referral line 210-592-5350 “Joint Commission COE.” Elite Care Emergency (HH Silver Sponsor) 24/7 full-service, no-wait, freestanding ER with board-certified physicians and RNs offering Elite Care advantage for patients.

Marketing Liaison Dlorah Martin 509-592-7998 dmartin@elitecareemergency.com Marketing liaison Kylyn Stark 210-978-4110 kstark@elitecareemergency.com www.elitecareemergency.com “When seconds count, Elite Care can make ALL the difference.”

Methodist Healthcare System (HH Silver Sponsor)

48 San Antonio Medicine • April 2016

Palmira Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com/ Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges.

Miranda Peck 210-482-3000 mipeck@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”

HUMAN RESOURCES

e-ESI (HHH Gold Sponsor) Locally owned since 1999, we believe it's all about relationships. We keep our partners compliant assisting with human resource administration/management, workers' compensation/risk management, benefit administration, and payroll. We help our partners concentrate on what they do best...Service their customers.

Lisa Mochel (210) 495-1171 lmochel@eesipeo.com www.eesipeo.com

Employer Flexible (HHH Gold Sponsor) Employer Flexible doesn’t simply lessen the burden of HR administration. We provide HR solutions to help you sleep at night and get everyone in the practice on the same page.

John Seybold 210-447-6518 jseybold@employerflexible.com www.employerflexible.com “BCMS members get a free HR assessment valued at $2,500.”

INSURANCE

Texas Medical Association Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance cov-

erage they need.

Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Frost Insurance (HHH Gold Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses.

Bob Farish 210-220-6412 bob.farish@frostbank.com www.frostbank.com “Business and personal insurance tailored to meet your unique needs.”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care.

Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

SWBC (HHH Gold Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus dedicated attention on our clients to ensure their lasting satisfaction and long-term relationships.

VP Community Relations Deborah Gray Marino 210-525-1241 DMarino@swbc.com Wealth Advisor Gil Castillo, CRPC® 210-321-7258 Gcastillo@swbc.com Ad Valorem Tax Advisor Nikki McNish 210.376.2316 nmcnish@swbc.com

www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services Catto & Catto (HH Silver Sponsor) Providing insurance, employee benefits and risk-management products and services to thousands of businesses and individuals in Texas and the United States.

James L. Hayne Jr. 210-222-2161 jhaynejr@catto.com Corey Huffman 210-298-7123 chuffman@catto.com www.catto.com Joel Gonzales Agency Nationwide (HH Silver Sponsor) Joel Gonzales 210-275-3595 www.nationwide.com/jgonzales

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies.

Patty Spann, 512-425-5932 patty-spann@tmlt.org www.tmlt.org “Recommended partner of the Bexar County Medical Society.”

MedPro Group (HHH Gold Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance.

Thomas Mohler, 512-213-7714 thomas.mohler@medpro.com Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians.

Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC, 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

The Doctors Company (HH Silver Sponsor) The Doctors Company is fiercely committed to defending, protecting, and rewarding the practice of good medicine. With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer. Learn more at www.thedoctors.com.

Susan Speed Senior Account Executive (512) 275-1874 Susan.speed@thedoctors.com Marcy Nicholson Director, Business Development (512) 275-1845 mnicholson@thedoctors.com “With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer” NORCAL Mutual Insurance Co. (HH Silver Sponsor) Since 1975, NORCAL Mutual has offered medical professional liability coverage to physicians and is “A” (Excellent) rated by A.M. Best.

Patrick Flanagan 844-4-NORCAL pflanagan@norcal-group.com www.norcalmutual.com ProAssurance (HH Silver Sponsor) ProAssurance Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease— that’s only fair.

Keith Askew, Market Manager kaskew@proassurance.com Mark Keeney Director, Sales mkeeney@proassurance.com 800.282.6242 www.proassurance.com

INTERNET/ TELECOMMUNICATIONS

210-323-7717 Ron Inselmann ron@pgxt.com 210-382-7761 www.PGXT.com

Regional Solutions Consultant Lilly Ibarra 210-714-9815 lilly.ibarra@kareo.com www.kareo.com

Time Warner Cable Business Class (HHH Gold Sponsor) When you partner with Time Warner Cable Business Class, you get the advantage of enterpriseclass technology and communications that are highly reliable, flexible and priced specifically for the medical community.

Darin Anderson 210-563-5230 Darin.anderson@twcable.com “Time Warner Cable Business Class offers custom pricing for BCMS Members.”

Clinical Pathology Laboratories (HH Silver Sponsor) Mitchell Kern 210-229-2513 mkern@cpllabs.com www.cpllabs.com

Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency.

Henry Miranda 210-340-5515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for yur account receivables.”

IT SUPPORT/VOIP/ CLOUD SERVICES

ICS (HHH Gold Sponsor) ICS® is a Texas-based provider of business technology integration solutions, including managed IT support, business telephones, VoIP communications, video conferencing systems, surveillance cameras, and voice/data cabling.

Family owned since 1981.

Daniel Simons 210-581-9020 daniel.simons@ics-com.net Robert Foehrkolb 210-225-5427 rfoehrkolb@ics-com.net www.ics-com.net “Providing IT, voice and video solutions for business.”

LABORATORY SERVICES

PGX TESTING (HHH Gold Sponsor) PGX Testing is a multi-faceted diagnostics company currently offering pharmacogenomics, urine toxicology, women's health testing, cancer screening, and wellness testing to the medical profession.

Charlie Rodkey Sr. charlie@pgxt.com 210-218-8610 Ryan Rodkey ryan@pgxt.com

MARKETING SERVICES

Digital Marketing Sapiens (HHH Gold Sponsor) Healthcare marketing professionals with proven experience and solid understanding of compliance issues. We deliver innovative marketing solutions that drive results.

Irma Woodruff 210-410-1214 irma@dmsapiens.com Ajay Tejwani 210- 913-9233 ajay@dmsapiens.com www.DMSapiens.com

MEDICAL BILLING AND COLLECTIONS SERVICES

DataMED (HHH Gold Sponsor) Providing your practice with the latest compliance solutions, concentrating on healthcare regulations affecting medical billing and coding changes, allowing you and your staff to continue delivering excellent patient care.

Betty Aguilar 210-892-2331 baguilar@datastreamllc.net www.datamedbpo.com “BCMS members receive a discounted rate for our billing services.”

Kareo (HHH Gold Sponsor) The only cloud-based medical office software and services platform purpose-built for small practices. Our practice management software, medical billing solution, practice marketing tools and free, fully certified EHR has helped 30,000+ medical providers more efficiently manage their practice.

MEDICAL SUPPLIES AND EQUIPMENT

Henry Schein Medical (HHHH 10K Platinum Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere.

Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”

CASA Physicians Alliance (HHH Gold Sponsor) Locally owned, nationwide Multi-Specialty Physicians Buying Group which provides significant savings on Pediatric, Adolescent and Adult vaccines as well as other products.

Physician’s memberships are free.

Shari Smith 866-434-9974 shari@casaalliance.net Chris Dixon 866-434-9974 chris@casaalliance.net www.casaalliance.net “Providing meaningful vaccine discount programs, products and services.”

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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Continued from page 49 MENTAL HEALTH EDUCATION AND CONSULTING

The Ecumenical Center (HHH Gold Sponsor) The Ecumenical Center provides faith-based counseling and education for healing, growth and wellness. The center is a catalyst, bringing together community leaders in research, education, ethics, medical and mental health professions.

Mary Beth Fisk 210-616-0885, ext. 215 mbfisk@ecrh.org www.ecrh.org

MERCHANT PAYMENT SYSTEMS/CARD PROCESSING Heartland Payment Systems (HH Silver Sponsor) Heartland Payments is a true cost payment processor exclusively endorsed by over 250 business associations.

Tanner Wollard, 979-219-9636 tanner.wollard@e-hps.com www.heartlandpaymentsystems.com “Lowered cost for American Express; next day funding.”

OFFICE EQUIPMENT/ TECHNOLOGIES Dahill (HH Silver Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes.

Ronel Uys 210-805-8200, ext. 10105 ruys@dahill.com www.dahill.com

employment experts providing solutions in all areas of human capital – Payroll, HR, Compliance, Performance Management, Workers’ Compensation, Risk Management and Employee Benefits.

Bryce Fegley 830-980-1245 bfegley@swbc.com Working together to help our clients achieve their business objectives.

PHYSICIANS BUYING GROUP

CASA Physicians Alliance (HHH Gold Sponsor) Locally owned, nationwide Multi-Specialty Physicians Buying Group which provides significant savings on Pediatric, Adolescent and Adult vaccines as well as other products.

Physician’s memberships are free.

Shari Smith 866-434-9974 shari@casaalliance.net Chris Dixon 866-434-9974 chris@casaalliance.net www.casaalliance.net “Providing meaningful vaccine discount programs, products and services.”

REAL ESTATE/ COMMERCIAL

San Antonio Comercial Advisors (HHH Gold Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”

PAYROLL SERVICES

SWBC (HHH Gold Sponsor) Our clients gain a team of

50 San Antonio Medicine • April 2016

Robbie Casey Commercial Realty (HHH Gold Sponsor)

Robbie Casey Commercial Realty was founded on the principles of providing thorough market strategies, innovative advertising, superior service, and uncompromising integrity. Robbie is dedicated to each of her clients. She brings enthusiasm and creativity to each project and knows how to get the job done.

Robbie Casey 210-872-8453 robbie@robbiecaseyrealty.com http://robbiecaseyrealty.com Endura Advisory Group (HH Silver Sponsor) Endura Advisory Group specializes in representing physicians and clients in the purchase, lease, sale, management or sublease of commercial real estate.

Vicki Cade, CCIM 210-366-2222 Mobile 210-827-7640 vcade@endurasa.com Teresa Corbin 210-366-2222 tcorbin@endurasa.com www.endurasa.com

REAL ESTATE/ RESIDENTIAL

Robbie Casey Realty (HHH Gold Sponsor) My extensive experience and expertise in the San Antonio, Alamo Heights and Terrell Hills real estate market will benefit you whether you are looking to buy or sell a home in the area.

Realtor, ABS, ILHM, ALMS Roslyn Casey 210-710-3024 Roslyn@roslyncasey.com http://roslyncasey.kwrealty.com “Communication is key” Kuper Sotheby's International Realty (HH Silver Sponsor) My hometown roots are based in Fredericksburg while my home away from home is San Antonio. Local knowledge — exceptional results.

Joe Salinas III 830-456-2233 Joe.Salinas@SothebysRealty.com JoeSalinas.com “Embrace your new life ...

I'll help you become a connoisseur.”

SENIOR LIVING Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with top-tier care while maintaining their privacy and independence, in a luxurious resort-quality environment.

Shane Brown Executive Director 210-305-5713 hello@ legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”

STAFFING SERVICES

Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle.

Brody Whitley, Branch Director 210-301-4362 bwhitley@ favoritestaffing.com www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

As of March 23, 2016 to join the Circle of Friends program or for more information, call 210-301-4366, email August.trevino@bcms.org, or visit www.bcms.org/COf.html.

Ancira Chrysler 10807 IH-10 West Gunn Acura 11911 IH-10 West

Ingram Park Auto Center 7000 NW Loop 410

Ancira Dodge 10807 IH-10 West Cavender Audi 15447 IH-10 West

* Gunn Infiniti 12150 IH-10 West

Ingram Park Auto Center 7000 NW Loop 410

Ingram Park Auto Center 7000 NW Loop 410

North Park Mazda 9333 San Pedro Ave.

North Park Subaru at Dominion 21415 IH-10 West

Mercedes-Benz of Boerne 31445 IH-10 W, Boerne

Cavender Toyota 5730 NW Loop 410

Ancira Jeep 10807 IH-10 West Ingram Park Auto Center 7000 NW Loop 410

Mercedes-Benz of San Antonio 9600 San Pedro Ave. Cavender Buick 17811 San Pedro Ave. (281 N @ Loop 1604)

Northside Ford 12300 San Pedro Ave.

Cavender GMC 17811 San Pedro Ave. Batchelor Cadillac 11001 IH-10 at Huebner

Tom Benson Chevrolet 9400 San Pedro Ave. Gunn Chevrolet 12602 IH-35 North

North Park Subaru 9807 San Pedro Ave.

* North Park Lexus 611 Lockhill Selma North Park Lexus Dominion 21531 IH-10 West Frontage Road

Ancira Nissan 10835 IH-10 West Ingram Park Nissan 7000 NW Loop 410

North Park Toyota 10703 SW Loop 410

* Ancira Volkswagen 5125 Bandera Rd. North Park VW at Dominion 21315 IH-10 West

Gunn GMC 16440 IH-35 North

* Fernandez Honda 8015 IH-35 South

* North Park Lincoln/ Mercury 9207 San Pedro Ave.

Ancira Ram 10807 IH-10 West Ingram Park Auto Center 7000 NW Loop 410

Gunn Honda 14610 IH-10 West (@ Loop 1604)

visit us at www.bcms.org

51

AUTO REVIEW

BMW 640i This is a strange time. Regular gas goes for about $1.40 per gallon in San Antonio, which translates to roughly 80 cents in 1990 money, yet automobile manufacturers are doing everything they can to get their vehicles to use less and less fuel. Why? Part of the reason is the reality of product development times — it takes a minimum of three years from green light to launch when a new vehicle is created, and even longer if a new engine is involved. And three years ago regular gas in San Antonio went for $3.40, more than twice what it is today.

Plus there’s the reality of ever-increasing emissions requirements, which compel automakers to produce cars and light trucks that emit almost no pollution.

A quick aside: when I was a child in the late 1960s and early ‘70s, cars routinely 52 San Antonio Medicine • April 2016

belched out clouds of toxic fumes that were an assault on every sense. Those days are totally over as all new vehicles routinely drive through places where what comes out of their tailpipes is cleaner than the ambient air.

A recent edmunds.com study found that a Ford F-150 had to drive a startling 3,800 miles before it produced the same pollution as a standard gas-powered leaf blower did in 30 minutes. Modern cars are very clean.

Nevertheless, they’re getting even cleaner, and a lot of the credit for that goes to countless engineers who somehow make each year’s automotive propulsion systems cleaner than the one the year before. The latest path to lower emissions involves turbocharging, and this change has proved to be so effective that I can’t imagine any diesel or gas powered internal combustion engine won’t have a tur-

By Steve Schutz, MD

bocharger (or two or three or more) in five years.

Cue the BMW 640i, a turbo-six cylinder luxury grand tourer that until recently was only available with a V8 engine in the U.S. (As noted below, it can still be ordered with a V8.) Based on the superb 5-series sedan platform, the “6” comes in coupe, convertible, or four-door Gran Coupe versions. I recently tested the coupe.

The exterior design of the 640i coupe is typical contemporary BMW, which is to say sleek and modern, but completely inoffensive. Ten to 15 years ago, the company was widely criticized for styling that was considered too avant-garde, and in response BMW has made all of their non-electric vehicles look almost anonymous. Whether that’s a good or bad thing depends on your point of

AUTO REVIEW

view, but strong BMW sales indicate that luxury car buyers in 2016 prefer low-key to in-your-face designs.

No one has been criticizing BMW interiors, and the 640i cabin doesn’t disappoint with rich looking materials and lots of tech.

From the wonderfully thick-rimmed steering wheel to the soft leather everywhere, and the tasteful wood, aluminum, or faux carbon fiber trim, everything inside the BMW 640i is just right. No, it’s not perfect like Audis seem to always be, but I’d call it a solid second place.

Driving the 640i is a pleasure, as you’d expect with a BMW. As long as you’re driving through town, over a country back road with a gentle curve, or on the interstate, the 640i is hard to beat.

With a curb weight of around 4,000 pounds, BMW’s nicest luxury coupe isn’t really up for attacking a challenging road with lots of twists, but I don’t expect many buyers

in this category are looking for that.

Rear-wheel drive and an eight-speed automatic transmission with paddle shifters are standard on all 6-series models, while the xDrive all-wheel-drive system — not likely to be popular in South Texas — is optional.

The 640i comes with a turbocharged 3.0liter inline-6 that produces 315 HP and is rated at 21 MPG city/32 highway, while the faster and costlier 650i with its turbo 4.4liter V8 generates 445 HP but gets you an uninspiring 17 MPG city/25 highway.

High performance M versions of all three 6-series body styles are available but won’t be discussed here. I doubt very many M6 buyers would even consider non-M cars, frankly.

They’re different animals entirely.

The 640i coupe starts at just under $80,000 with no options, but prices can climb rapidly toward $100,000. Nevertheless, the standard 640i is anything but a stripper providing leather/heated/memory front seats, a Bang & Olufsen audio system, heads-up display, dynamic cruise control,

and LED headlights.

As always, Phil Hornbeak will happily walk you through the many packages and stand-alone options of the 640i or any other vehicle to find the one that’s right for you.

While it’s odd to find so many increasingly fuel efficient cars like the 640i available at a time when gasoline is so cheap, it’s good to know that better fuel efficiency doesn’t necessarily cost you power, driving pleasure, or luxury. If future cars save even more gas but are as nice to live with as the 640i, I’m going to embrace that green future.

If you’re in the market for this kind of vehicle, call Phil Hornbeak at 210-301-4367.

Steve Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine since 1995. visit us at www.bcms.org

53

THANK YOU

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54 San Antonio Medicine • April 2016

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